1. Reimbursement ratio of outpatient: general outpatient without a starting line, all insured residents are entitled to general outpa
1. Reimbursement ratio of outpatient: general outpatient without a starting line, all insured residents are entitled to general outpatient treatment. A medical insurance year, general outpatient does not set a starting line, into the outpatient co-ordination fund within the scope of payment of medical expenses reimbursement at the rate of 60%, the co-ordination fund annual individual maximum payment limit of 400 yuan;
2, hospitalization reimbursement ratio: the longer the continuous participation in the reimbursement ratio of the greater the insured residents continuous payment for every five years, the medical insurance fund hospitalization reimbursement ratio increased by 5 percentage points, the cumulative total of not more than 10 percentage points, the hospitalization reimbursement ratio. The cumulative total shall not exceed 10 percentage points. If you have been insured for 10 consecutive years since 2007, the reimbursement rate for hospitalization in a tertiary, secondary, or primary hospital is 70%, 80%, and 90%, respectively;
3, secondary reimbursement rate: "secondary reimbursement" may be followed by "reimbursement". "
The medical expenses incurred by an insured resident who is hospitalized several times a year shall be reimbursed at a rate of 55% by the funds of the major disease insurance for the part of his/her annual hospitalization medical expenses (including reasonable out-of-pocket expenses) that exceeds RMB 25,000 yuan after the payment by the basic medical insurance and the "secondary reimbursement". The annual individual payment limit of the major disease insurance fund is 250,000 yuan;
4. Reimbursement amount: the annual maximum reimbursement of 370,000 yuan for residents who participate in the city's urban residents' medical insurance, the annual payment limit of the basic medical insurance is 120,000 yuan, and the payment limit of the major disease insurance is 250,000 yuan. limit is 250,000 yuan. Therefore, YINO Finance found that participants can be reimbursed up to 370,000 yuan per year.
The process of reimbursement of medical insurance for medical treatment in a different place:
1, get or download from the social security website the "Municipal basic medical insurance for people working and living in a different place" (hereinafter referred to as the "Declaration Form");
2, fill in the form according to the regulations, and by the field of social insurance (medical insurance) agencies stamped with a seal of recognition of the Declaration Form;
3, will be filled out after the The "Declaration Form" will be taken back to the social insurance agency responsible for the division of labor for examination and confirmation. To apply for the province's medical card, after the audit and confirmation of the "declaration form" to the municipal social security center audit section for registration, and then to the social security card management section for the province's network of cards for the preparation of the card;
4, for the preparation of the individual social security card can not be used in the participant's personal social security card; participants to return to have to be in the medical treatment should be cancelled to the municipal social security institutions to medical preparation from the next day onwards, the individual social security card can be used in the designated medical treatment;
5, the social security card can be used in the medical treatment of the individual Social security card can only be used in the designated medical institutions;
5, the implementation of medical reporting changes in the report, the principle of non-reporting without change.
In summary, medical insurance is the protection of the life of our citizens after retirement, so we need to pay enough attention, if you find your rights and interests have been harmed, you should seek the relevant departments in a timely manner to solve the problem.
Legal basis:
Article 28 of the Social Insurance Law of the People's Republic of China
Medical expenses in line with the basic medical insurance drug catalog, diagnostic and therapeutic items, standards of medical service facilities, as well as emergency and rescue, shall be paid from the basic medical insurance fund in accordance with state regulations.
Article 29
The portion of the medical expenses of the insured that should be paid by the basic medical insurance fund shall be settled directly between the social insurance administration organization and the medical institutions and drug business units. The administrative departments of social insurance and the administrative departments of health shall establish a settlement system for medical expenses incurred for medical treatment in other places, so as to facilitate the enjoyment of basic medical insurance by insured persons.